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PubMed1978

Falls in the institutionalized elderly.

The reports on 72 of 190 accidents occurring among 189 nursing home residents during a 3-month period were drawn at random and reviewed. The majority of the accidents were falls, either major or minor. Personal data on the residents included age, sex, mental status, number of diseases, and number of drugs administered. Data on environmental factors included the time of day and location of the accident, and the concomitant nursing staff patterns. Women of advanced age were more likely to be involved in a major fall, whereas younger men were more likely to be involved in a minor one. Alert, wheelchair-bound elderly patients were at the highest risk, whereas those who used assistive devices were at the lowest risk. Falls were directly related to the number of diseases present and the use of drugs. Most accidents occurred at the bedside during the evenings and nights, with the greatest frequency during the changes in nursing shifts or when the patient was either rising or retiring.

Accidents↗
PubMed1980

Anemia in institutionalized elderly patients.

In a one-year period (1976--1977), 161 residents of a long-term facility were evaluated. There were 44 men and 117 women. According to criteria established by the World Health Organization, 64 residents (40 percent) were anemic. The incidence was greater for women than for men. The peak incidence occurred in the 71--80 age group for women, and in the 90+ age group for men. Iron deficiency secondary to surgical procedures, gastrointestinal bleeding or anticoagulant therapy was the most common cause of correctable anemia. Of the 64 anemic patients, 42 percent responded to therapy. Anemia among the elderly in institutions is often reversible, unlike the anemia of chronic disease. Evaluation should include a careful history and physical examination plus readily available laboratory findings. Invasive procedures are rarely indicated.

Adult↗
PubMed1981

Dementia and other competing risks for mortality in the institutionalized aged.

The relative importance of dementia, gender, age and functional status (FS) was examined for relationships to mortality within five years after admission of the subjects to a New York City nursing home for the aged. Using a random sample of 212 of the nursing home's patients, a statistical model was developed to estimate the relative risk of mortality. When this model was cross-validated on an independent sample of 118 residents, it failed to show significant lack of fit. Given these results, an international model was developed by combining the New York City samples(N = 330) and comparing them to a sample (N = 363) from a nursing home in Tokyo, Japan. In the new York model, gender was the most important predictor, with age and dementia next in importance; FS was not a significant predictor. Despite the apparent differences in the types of dementia in the New York and Tokyo nursing homes, the mortality patterns were similar.

Age Factors↗
PubMed1985

Factors affecting the use of influenza vaccine in the institutionalized elderly.

Annual influenza vaccination has been recommended for the past four years for all the patients residing on the extended-care facility of this large county hospital. During the fall of 1983, baseline data was collected regarding compliance with these recommendations. It was found that only 33% of the high-risk individuals had been vaccinated. A study was planned to investigate the factors for poor compliance rate and explore alternate methods of delivery of the vaccine. Despite the physician's strong belief in the vaccine, all methods of reminders to the physicians failed to have significant impact on increased use of the influenza vaccine. Finally an institutional policy pertaining to a standing order for the influenza vaccine was approved by the Infection Control Committee and the hospital Medical Staff Committee and 95% of the patients on the extended-care facility of this hospital were immunized.

Aged↗
PubMed1986

Autopsy proven pulmonary embolism among the institutionalized elderly.

The presentation of pulmonary embolism is variable in the elderly as in any age group. Common symptoms such as chest pain, dyspnea, and hemoptysis may be absent. Furthermore, precursors such as phlebitis, malignancy, and recent surgery often may be absent as well. Our intent was to examine the occurrence in a long-term care institution of pulmonary embolism at autopsy and the extent of missed antemortem diagnosis of this condition, and to compare patients with and without pulmonary embolism by chart and autopsy review. The incidence of pulmonary embolism in our study of elderly patients during a six-year period in a teaching nursing home was 12.8%. Although our series is small, consisting of 47 autopsies, our results are in accord with reports from other patient sites. Few autopsies are performed on nursing home patients and even fewer have been studied with regard to the occurrence and characteristics of pulmonary embolism in this population. The diagnosis remains difficult and uncertain, especially so in the elderly, because of the variability of presentation and association, the lesser pursuit of aggressive or invasive diagnostic methods, and the paucity of postmortem documentation.

Aged↗
PubMed1987

Sexuality and the institutionalized elderly.

Sexuality is considered to be among the more disturbing sexual problems in skilled nursing facilities. Staff attitudes and beliefs often lead to discomfort in dealing with the continued sexual interests of patients. It is clear that if sexuality has been an important part of self-image and of coping, then it remains important. Staff reaction to two cases is used to illustrate the need for programmatic interventions with staff, residents, and families.

Aged↗
PubMed1988

Determinants of total serum carotene concentrations in institutionalized elderly.

The current analysis was designed to examine further the association between total serum carotenoids and a series of preselected variables (dietary intakes, anthropometric parameters, serum cholesterol, vitamin A, transport proteins, and others) using 85 elderly patients. Simple correlation between serum carotene and carotene intake, as estimated by a three-day weighed method, was 0.19 (P = 0.08), which was substantially increased (r = 0.29, P = 0.01) after adjustments for a selected set of variables. Standardized coefficients of multivariate regression indicated that the most important predictors of serum carotene were serum cholesterol (beta = 0.38), total serum proteins (beta = -0.35), and sex (beta = 0.34), followed by carotene intake (beta = 0.28) and midarm circumference (beta = 0.20). These variables accounted for 46% of the variance. Results suggest that serum carotene may be related to protein-energy status in hospitalized elderly, but further investigation should be directed to serum carotene in undernourished elderly. Nevertheless, total serum proteins could be an important factor in any attempt to correlate carotene intake and blood concentration.

Aged↗
PubMed1991

The utilization of fecal occult blood testing in the institutionalized elderly.

OBJECTIVE: To examine physician use of stool guaiac testing in order to determine indications for testing, how the test was used, and the consequences of a particular test result. DESIGN: Retrospective case series. SETTING: Large midwestern inpatient nursing home facility. PATIENTS: All patients with positive fecal occult blood tests (FOBT) and one-third of patients with negative FOBT. RESULTS: In an 18-month period, 916 occult blood tests were performed on 339 patients (37% of the nursing home census). Patients over age 90 were as likely to receive FOBT as those under age 70. Fourteen percent of those tested had at least one positive test. Fifty-eight percent of the patients with positive tests underwent no additional diagnostic testing. No cause for the positive FOBT was found for 68% of patients receiving the test for routine screening. Physician estimates of how frequently they employed FOBT for these patients correlated very poorly with their actual practices (r = .17). CONCLUSION: There is a high prevalence of positive results from FOBT among nursing home patients. In most cases, such results do not cause a change of therapy or result in additional workup. Lack of information on the role of FOBT in nursing home patients contributes to the great diversity in utilization of this test by nursing home physicians.

Aged↗
PubMed1991

Nursing home resources and tranquilizer use among the institutionalized elderly.

OBJECTIVE: To examine the relationship between selected resident and facility characteristics and the frequency and quality of tranquilizer prescribing and use in skilled nursing facilities. DESIGN: Retrospective review of medication profiles and pharmacy billing records using standardized protocol. SETTINGS: Seven skilled nursing facilities. PARTICIPANTS: All residents aged 65 years or older were eligible. Consent was given by 760 residents or guardians. Six refused permission. OUTCOME MEASURES: Drug use measures included the presence or absence of a tranquilizer order, any tranquilizer use during previous 30 days, and any deviation from selected drug use criteria. RESULTS: Of 760 residents, 38% had an order for an antipsychotic or antianxiety agent, and 28% actually received a tranquilizer. Comparing tranquilizer practices with specific drug-use criteria showed that nearly 19% of all elderly residents were exposed to some type of excess use such as long duration, polymedicine, or therapeutic duplication. Residents in facilities with less adequate staffing and other resources were significantly more likely to have a tranquilizer order, to have a tranquilizer administered, and to have any deviation from drug-use criteria. The data also show higher rates of deviation from criteria among residents with a diagnosed mental disorder, younger residents, and Medicaid recipients. CONCLUSION: More attention must be paid to environmental factors that may undermine current efforts to improve psychotropic drug prescribing and use in skilled nursing facilities.

Aged↗
PubMed1992

A prospective study of pressure sore risk among institutionalized elderly.

OBJECTIVE: To determine if dietary intake, nutritional status, and other physical markers are risk factors for the development of pressure sores in the elderly. DESIGN: Cohort study. SETTING: 250-bed skilled nursing facility with 90 extended care beds in which the average length of stay is 28 days. PATIENTS: Two hundred newly admitted residents (70% female, 95% Caucasian) who were over age 65, estimated to stay greater than 10 days, at risk for pressure sore development (Braden Scale score less than or equal to 17) but free of existing pressure sores were studied for 12 weeks or until discharge. MEASURES: Skin assessment, Braden Scale score, blood pressure, body temperature, anthropometrics, and dietary intake were studied weekly. CBC, serum albumin, serum total protein, serum iron, iron binding capacity, serum zinc and copper, and serum vitamin C were studied weekly for 4 weeks and biweekly for 8 weeks. MAIN OUTCOME MEASURES: Presence/absence and stage of pressure sores. MAIN RESULTS: Stage I pressure sores developed in 70 (35%) and Stage 2 or worse in 77 (38.5%) residents. Subjects who developed pressure sores were older (P less than 0.001) and had lower systolic and diastolic blood pressure (P less than 0.001) and higher body temperature (P less than 0.001) than those without pressure sores. Dietary intake of all nutrients was lower among subjects who developed pressure sores. Using logistic regression, the best predictors or pressure sore development were the Braden Scale score, diastolic blood pressure, temperature, dietary protein intake, and age. CONCLUSIONS: Risk assessment is recommended upon admission to a nursing home and weekly for the first month. Risk status can be effectively predicted by using the Braden Scale in combination with knowledge of age, blood pressure, temperature, and dietary protein intake.

Age Factors↗
PubMed1995

Weight gain impacts morbidity and mortality in institutionalized older persons.

OBJECTIVE: To determine if a significant weight change in previously undernourished older persons is associated with mortality and morbidity. DESIGN: Retrospective survey. SETTING: A chronic care hospital in Canada. SUBJECTS: Follow-up survey from an original data set (Time 1) on 88 previously diagnosed undernourished and 60 adequately nourished. Average age was 78 years; average length of residence was 40 months. Of the 148 subjects, 120 were male. MEASUREMENTS: Average time to follow-up (Time 2) was 319 days from Time 1. Data was collected on weight change, reported incidence of infection, use of antibiotics, number of falls, and admissions to acute centers, as well as incidence and cause of death. Three-day diet intake records were available on 15% of subjects within 1 month of Time 2. Five nutritional groups existed within this follow-up population: those previously undernourished who gained at least 5% of Time 1 weight (Group 1), those undernourished who lost at least 5% of Time 1 weight (Group 2), those undernourished who maintained their weight (Group 3), those adequately nourished who lost at least 5% of original weight (Group 4), and those who remained adequately nourished (Group 5). RESULTS: Forty-one of the 148 patients died; this was significantly associated with nutrition group (X2 = 11.23, P = 0.02), with fewer deaths in Groups 1, 3, and 5. As well, primary diagnosis (x2 = 32.6, P = 0.001), length of residence (X2 = 25.6, P = 0.01), and time to death (X2 = 26.4, P = 0.009) were significantly associated with nutrition group. Diet intake records indicated an improvement in energy and protein intake in Group 1 during the follow-up. Energy and protein change, whether increased or decreased from the original study, was significantly associated with nutrition group. Total number of feeding impairments and presence of dysphagia were significantly associated with nutrition group. Other morbidity events were not significantly associated with nutrition group, but trends suggest a positive effect of weight gain on incidence of falls, incidence of more than two infections, and incidence of recurring infections. CONCLUSIONS: A weight increase of at least 5% of body weight in previously undernourished patients is associated with a decreased incidence of death and may reduce morbidity events. Feeding impairments may affect ability of patients to gain weight, but dysphagia is associated with weight increase. Other nonnutritional variables of diagnosis, number of medications, and declining medical status also affect mortality and morbidity outcomes.

Accidental Falls↗
PubMed1997

Seasonal prevalence of vitamin D deficiency in institutionalized older adults.

OBJECTIVE: To determine the prevalence and seasonal variation of vitamin D deficiency among older residents of long-term care facilities. DESIGN: Cross-sectional survey with 6-month follow-up. SETTING: Three long-term care facilities in Toronto. PATIENTS: Persons more than 65 years old, medically stable, who had resided in the facility for at least 6 months and had no conditions known to interfere with vitamin D metabolism. MEASUREMENTS: Information regarding demographics, past health, and medication use was collected. Mental and functional status were assessed by questionnaire. Venous blood samples were analyzed for alkaline phosphatase, calcium profile, albumin, intact parathyroid hormone, 25 hydroxyvitamin D (25OHD), and vitamin D binding protein in September 1994 and March 1995. In a subgroup of patients, bone specific alkaline phosphatase was measured, and dietary intake of vitamin D was assessed. RESULTS: A total of 155 subjects completed the study. The mean age of the subjects was 83.2 years (SD 7.1), and 47% were female. The mean 25OHD level in the March sample (39.9 nmol/L, SD 19.7) was significantly lower than the mean 25OHD level in the September sample (44.9 nmol/L, SD 16.9) (P = .001). The prevalence of vitamin D deficiency in the osteomalacic range (25OHD < 25 nmol/L) increased from 9% in the fall sample to 18% after the winter (chi 2 = 4.65, P = .03). The prevalence of borderline deficiency or hypovitaminosis D (25OHD < 40 nmol/L) increased from 38% in the fall sample to 60% in the spring sample (chi 2 = 14.9, P < .001). Dependence in transfers was associated with an increased risk of hypovitaminosis D, odds ratio 2.08 (95% confidence interval 1.08-4.01), dependence in ambulation 2.57 (1.26-5.23), and regular use of a wheelchair 2.17 (1.09-4.31). When entered into a forward conditional logistic regression model, only dependence in ambulation remained significant, with an adjusted odds ratio of 2.57 (95% CI: 1.26-5.18). CONCLUSIONS: Vitamin D deficiency and borderline vitamin D status are common among older residents of long-term care facilities in Canada. Even though this population has limited outdoor exposure, seasonal variation in the prevalence of deficiency remains significant. Evaluation of interventions to improve the status of vitamin D nutrition in this population is needed.

Aged↗

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